Evolution of European Resuscitation and End-of-Life Practices from 2015 to 2019: A Survey-Based Comparative Evaluation

Spyros D Mentzelopoulos, Keith Couper, Violetta Raffay, Jana Djakow, Leo Bossaert, Spyros D Mentzelopoulos, Keith Couper, Violetta Raffay, Jana Djakow, Leo Bossaert

Abstract

Background: In concordance with the results of large, observational studies, a 2015 European survey suggested variation in resuscitation/end-of-life practices and emergency care organization across 31 countries. The current survey-based study aimed to comparatively assess the evolution of practices from 2015 to 2019, especially in countries with "low" (i.e., average or lower) 2015 questionnaire domain scores.

Methods: The 2015 questionnaire with additional consensus-based questions was used. The 2019 questionnaire covered practices/decisions related to end-of-life care (domain A); determinants of access to resuscitation/post-resuscitation care (domain B); diagnosis of death/organ donation (domain C); and emergency care organization (domain D). Responses from 25 countries were analyzed. Positive or negative responses were graded by 1 or 0, respectively. Domain scores were calculated by summation of practice-specific response grades.

Results: Domain A and B scores for 2015 and 2019 were similar. Domain C score decreased by 1 point [95% confidence interval (CI): 1-3; p = 0.02]. Domain D score increased by 2.6 points (95% CI: 0.2-5.0; p = 0.035); this improvement was driven by countries with "low" 2015 domain D scores. In countries with "low" 2015 domain A scores, domain A score increased by 5.5 points (95% CI: 0.4-10.6; p = 0.047).

Conclusions: In 2019, improvements in emergency care organization and an increasing frequency of end-of-life practices were observed primarily in countries with previously "low" scores in the corresponding domains of the 2015 questionnaire.

Keywords: emergency care; ethics; resuscitation; surveys and questionnaires; terminal care.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of responses to the 2019 questionnaire.
Figure 2
Figure 2
Summary results on the primary study outcome. Boxplot presentation of subscores and scores of domains (A–D) of the study questionnaire. Data originate from the 25 participating countries. Bars reflect median value; box height reflects interquartile range; bars on top or bottom of the boxes reflect actual range of values; symbols (circles and asterisk) reflect countries with outlier score values, that is, score values outside the range that corresponds to box height plus the bars. †, p < 0.05 vs. 2015; ‡, p ≤ 0.01 vs. 2015.
Figure 3
Figure 3
Summary results on the secondary study outcome. Boxplot presentation of subscores and scores of domains (A–D) of the study questionnaire. Data originate from countries with “low” 2015 domain scores (n = 13 for domains (A,C); n = 15 for domain (B); and n = 9 for domain (D)). Bars reflect median value; box height reflects interquartile range; bars on top or bottom of the boxes reflect actual range of values; symbols (circles and asterisk) reflect countries with outlier score values, that is, score values outside the range that corresponds to box height plus the bars. †, p < 0.05 vs. 2015; ‡, p ≤ 0.01 vs. 2015.

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